Clinical Utility of the FilmArray® Blood Culture Identification (BCID) Panel for the Diagnosis of Neonatal Sepsis.

This prospective single-center study was designed to assess the clinical utility of the FilmArray® blood culture identification (BCID) panel for improving the diagnostic accuracy in neonatal sepsis. Results obtained using the FilmArray® BCID panel were correlated with results of blood culture in all consecutive neonates with suspicion of early-onset (EOS) and late-onset sepsis (LOS) attended in our service over a two-year period. A total of 102 blood cultures from 92 neonates were included, 69 (67.5%) in cases of EOS and 33 (32.3%) in LOS. The FilmArray® BCID panel was performed in negative culture bottles at a median of 10 h of blood culture incubation (IQR 8-20), without differences by the type of sepsis. The FilmArray® BCID panel showed a 66.7% sensitivity, 100% specificity, 100% positive predictive value, and 95.7% negative predictive value. There were four false-negative cases, three of which were Streptococcus epidermidis in neonates with LOS, and there was one case of Granulicatella adiacens in one neonate with EOS. We conclude that the use of the FilmArray® BCID panel in negative blood cultures from neonates with clinical suspicion of sepsis is useful in decision-making of starting or early withdrawal of empirical antimicrobials because of the high specificity and negative predictive values of this assay.

Postnatal Growth Faltering: Growth and Height Improvement at Two Years in Children with Very Low Birth Weight between 2002-2017.

The prevalence of postnatal growth faltering (PGF) in preterm infants with very low birth weight (VLBW) (<1500 g) is a universal problem. Growth improvement is expected as neonatal care is optimized. Objectives: To determine if there has been a decrease in the prevalence of PGF and an improvement in height at 2 years in appropriate for gestational age VLBW children in the last two decades. Methods: Clinical descriptive retrospective analysis of neonatal somatometry at birth and at two-year corrected age in VLBW preterm infants. Small for gestational age were excluded. Two cohorts (2002−2006, n = 112; and 2013−2017, n = 92) were compared. Results. In the second five-year period, a decrease in prevalence of PGF was observed (36.6% vs. 22.8%, p = 0.033), an increase in growth rate in the first 28 days (5.22 (4.35−6.09) g/kg/day vs. 11.38 (10.61−12.15) g/kg/day, p < 0.0001) and an increase in height standard deviation (SD) at 2 years (−1.12 (−1.35−−0.91) vs. −0.74 (−0.99−−0.49) p = 0.023). Probability of short stature at 2 years was directly related to daily weight gain in the first 28 days. Conclusions: when comparing two five-year periods in the last two decades, growth in VLBW preterm infants has improved, both during neonatal period and at two years of age.

Predicción del crecimiento a los dos años utilizando las gráficas de Fenton e Intergrowth-21 en menores de 1.500 g / Growth outcome at 2 years using Fenton and Intergrowth-21st charts in infants less than 1500 g

Introducción: No existe consenso sobre qué gráfica neonatal es mejor utilizar en niños con muy bajo peso al nacer (MBPN). El objetivo del estudio fue comparar las gráficas de Fenton 2013 e Intergrowth-21st (IW-21) con base en su capacidad predictora de la somatometría a los dos años, así como analizar factores relacionados con talla baja a los dos años. Material y métodos: Cohorte de niños con MBPN nacidos entre 2002-2017. Se analizó la asociación entre la somatometría neonatal (z-score por Fenton e IW-21) y el riesgo de talla baja (< -2 desviación estándar [DS]), perímetro craneal < -2 DS y desnutrición a los 2 años (IMC < -2 DS) (gráficas OMS). Resultados: Se incluyeron 513 niños con una edad gestacional media de 30,05 ± 2,5 semanas. El z-score del peso al nacimiento y al alta por Fenton y por IW-21 resultaron útiles para predecir riesgo de talla baja y desnutrición a los dos años (sin diferencias en el AUC de las curvas ROC), siendo el z-score al alta útil además para predecir perímetro craneal < -2D. A los dos años, la prevalencia de talla baja, perímetro craneal < -2 DS, y desnutrición fue del 17,2, 4,1 y 6,1%, respectivamente. El bajo peso para la edad gestacional y la duración del ingreso neonatal se identificaron como factores de riesgo independientes para talla baja a los dos años. Conclusiones: El z-score peso al alta resulta útil para predecir riesgo de talla baja, desnutrición y perímetro craneal < -2 DS a los dos años en niños con muy bajo peso al nacer, sin diferencias estadísticas entre utilizar las gráficas de Fenton o IW-21. (AU)

Introduction: There is no consensus on which neonatal chart is best to use in very low birth weight (VLBW) infants. The aim of the study was to compare the Fenton 2013 and Intergrowth-21st (IW-21) charts based on their predictive ability for somatometry at 2 years, as well as to analyze factors related to short stature at 2 years. Material and methods: Cohort of children with VLBW born in 2002–2017. Association between neonatal somatometry (z-score by Fenton and IW-21) and risk of short stature (< −2 DS), head circumference < −2 DS and malnutrition at 2 years (BMI < −2 DS) was analyzed (WHO charts). Results: 513 children with a mean gestational age of 30.05 ± 2.5 weeks were included. Birth and discharge weight z-score by Fenton and IW-21 were useful for predicting risk of short stature and malnutrition at 2 years (without differences in the AUC of the ROC curves). Weight z-score at discharge was also useful for predicting head circumference < −2 DS. At 2 years, prevalence of short stature, head circumference < −2 DS, and malnutrition was 17.2, 4.1, and 6.1%, respectively. Low weight for gestational age and length of stay were identified as independent risk factors for short stature at 2 years. Conclusions: Discharge weight z-score is useful for predicting risk of short stature, malnutrition and head circumference < −2 DS at 2 years in very low birth weight children, with no statistical difference between using Fenton or IW-21 charts. (AU)

Growth outcome at 2 years using Fenton and Intergrowth-21st charts in infants less than 1500 g.

INTRODUCTION: There is no consensus on which neonatal chart is best to use in very low birth weight (VLBW) infants. The aim of the study was to compare the Fenton 2013 and Intergrowth-21st (IW-21) charts based on their predictive ability for somatometry at 2 years, as well as to analyze factors related to short stature at 2 years. MATERIAL AND METHODS: Cohort of children with VLBW born between 2002 and 2017. Association between neonatal somatometry (z-score by Fenton and IW-21) and risk of short stature (<-2 DS), head circumference <-2 DS and malnutrition at 2 years (BMI < -2 DS) was analyzed (WHO charts). RESULTS: 513 children with a mean gestational age of 30.05 ± 2.5 weeks were included. Birth and discharge weight z-score by Fenton and IW-21 were useful for predicting risk of short stature and malnutrition at 2 years (without differences in the AUC of the ROC curves). Weight z-score at discharge was also useful for predicting head circumference < -2 DS. At 2 years, prevalence of short stature, head circumference < -2 DS, and malnutrition was 17.2, 4.1, and 6.1%, respectively. Low weight for gestational age and length of stay were identified as independent risk factors for short stature at 2 years. CONCLUSIONS: Discharge weight z-score is useful for predicting risk of short stature, malnutrition and head circumference < -2 DS at 2 years in very low birth weight children, with no statistical difference between using Fenton or IW-21 charts.

Extrauterine Growth Restriction in Very Low Birth Weight Infants: Concordance Between Fenton 2013 and INTERGROWTH-21st Growth Charts.

Postnatal growth restriction has high prevalence in very low birth weight (VLBW) preterm neonates, and this could affect their long-term prognosis. Nowadays, there is no consensus on how to monitor growth in these neonates. Objective: This study aimed to compare prevalence of intra- and extrauterine growth restriction (IUGR and EUGR) in a sample of VLBW infants according to the Fenton 2013 charts and INTERGROWTH-21st (IW-21) standards and to analyze concordance between both in the different EUGR definitions criteria (cross-sectional, dynamic, and true). Patients and Methods: An observational retrospective study of 635 VLBW preterm was performed. The study was carried out in Central University Hospital of Asturias. Body measurements (weight, length, and head circumference) were collected at birth and at hospital discharge and expressed in z-scores for the two references (Fenton 2010 and IW-21). Kappa concordance was calculated. Results: Kappa concordance between Fenton and IW-21 was 0.887 for IUGR and 0.580 for static EUGR. Prevalence was higher according to Fenton in IUGR (36.5 vs. 35.1%), in static EUGR (73.8 vs. 59.3%), and in dynamic EUGR (44.3 vs. 29.3%). Despite observing low prevalence of EUGR when IW-21 was used to define EUGR, a statistical association between neonatal morbidity and diagnosis of EUGR was observed. Conclusion: The Fenton and IW-21 concordance for IUGR is good. IW-21 is more restrictive than Fenton in EUGR. Patients diagnosed by IW-21 as EUGR are more likely to have neonatal morbidity, especially if we use EUGR dynamic definition. In our study, we cannot conclude that one graph is better than the other.

Seroprevalence and epidemiology of hepatitis B and C viruses in pregnant women in Spain. Risk factors for vertical transmission.

BACKGROUND & AIM: Worldwide, measures are being implemented to eradicate hepatitis B (HBV) and C (HCV) viruses, which can be transmitted from the mother during childbirth. This study aims to determine the prevalence of HBV and HCV in pregnant women in Spain, focusing on country of origin, epidemiological factors and risk of vertical transmission (VT). METHODOLOGY: Multicentre open-cohort study performed during 2015. HBV prevalence was determined in 21870 pregnant women and HCV prevalence in 7659 pregnant women. Epidemiological and risk factors for VT were analysed in positive women and differences between HBV and HCV cases were studied. RESULTS: HBV prevalence was 0.42% (91/21870) and HCV prevalence was 0.26% (20/7659). Of the women with HBV, 65.7% (44/67) were migrants. The HBV transmission route to the mother was unknown in 40.3% of cases (27/67) and VT in 31.3% (21/67). Among risk factors for VT, 67.7% (42/62) of the women had viraemia and 14.5% (9/62) tested HBeAg-positive. All of the neonates born to HBV-positive mothers received immunoprophylaxis, and none contracted infection by VT. In 80% (16/20) of the women with HCV, the transmission route was parenteral, and nine were intravenous drug users. Viraemia was present in 40% (8/20) of the women and 10% (2/20) were HIV-coinfected. No children were infected. Women with HCV were less likely than women with HBV to breastfeed their child (65% vs. 86%). CONCLUSIONS: The prevalences obtained in our study of pregnant women are lower than those previously documented for the general population. Among the women with HBV, the majority were migrants and had a maternal family history of infection, while among those with HCV, the most common factor was intravenous drug use. Despite the risk factors observed for VT, none of the children were infected. Proper immunoprophylaxis is essential to prevent VT in children born to HBV-positive women.

Factors Associated with the Selection of First-line Bevacizumab plus Chemotherapy and Clinical Response in HER2-negative Metastatic Breast Cancer: ONCOSUR AVALOX Study.

AIM: To evaluate factors associated with the selection of first-line bevacizumab plus chemotherapy and clinical response in HER2-negative metastatic breast cancer (MBC) in clinical practice in Spain. PATIENTS AND METHODS: All consecutive adult female patients with HER2-negative MBC who had received first-line bevacizumab plus chemotherapy for at least 3 months were enrolled in the present study. RESULTS: A total of 292 evaluable patients were included; 25% had triple-negative breast cancer (TNBC) and 75% had hormone receptor-positive breast cancer (HRPBC). Nearly 40% of patients had ≥3 metastatic sites, mainly located in the bone (48%) and liver (40%). Bevacizumab was mostly combined with paclitaxel (67.1%). ER-positive tumors were only identified as an independent factor associated with the choice of treatment (odds ratio (OR): 0.538; p=0.02). The overall response rate (ORR) was 63.7% (TNBC: 57.5%; HRPBC: 65.9%). Patients aged 36-50 years (OR: 3.03; p=0.028) and those with metastases at sites other than the bone (OR: 0.38; p=0.001) and ≥3 metastatic sites (OR: 1.41; p=0.018) were more likely to achieve objective responses. CONCLUSION: First-line bevacizumab plus chemotherapy, mainly paclitaxel, is an effective and well-tolerated treatment option for HER2-negative MBC, particularly in more aggressive disease.

Focal Dermal Hypoplasia Due to De Novo Mutation c.1061T>C(p.Leu354Pro) in the PORCN Gene: Importance of Early Diagnosis and Multidisciplinary Follow-Up.

Focal dermal hypoplasia (FDH) is a rare multisystem disorder characterized by abnormalities in tissues derived from the meso-ectoderm, mainly affecting the skin, eyes, teeth and skeleton. We present the case of a young girl with FDH due to de novo mutation c.1061T>C (p.Leu354Pro) in the PORCN gene, responsible for defects in bone, eyes, skeleton, heart, maxillary and anus/rectum malformation. At birth, an infectious etiology and cutaneous syndromes that produce similar skin lesions were ruled out. Clinical manifestations led to the diagnosis of FDH, subsequently confirmed by genetic studies during the neonatal period. Early diagnosis allows organizing a detailed and personalized follow-up, which makes interventions more effective. This has contributed to satisfactory development to date in our patient. These patients present a host of possible complications requiring the coordinated effort of a multidisciplinary medical team from the start, all coordinated by a pediatrician.

Hijo de madre con síndrome de HELLP: características y papel de la prematuridad, bajo peso y leucopenia en su evolución / Newborn of mother with HELLP syndrome: characteristics and role of prematurity, low birth-weight and leukopenia in evolution

ResumenIntroducción: El síndrome de HELLP es un grave trastorno hipertensivo del embarazo con importantes problemas neonatales en los hijos de las madres afectadas. El objetivo de este trabajo fue conocer las características de estos neonatos y su evolución.Métodos: Se llevó a cabo un estudio observacional descriptivo y retrospectivo de los neonatos hijos de madre con síndrome de HELLP, nacidos en un hospital universitario entre el 1° de enero de 2008 y el 31 de diciembre de 2013. Se estudiaron 33 neonatos procedentes de 28 gestaciones (cinco gemelares). Se realizó un análisis descriptivo y comparativo entre grupos, y posteriormente un análisis de multivarianza de factores asociados con la mortalidad dentro de la serie.Resultados: De 33 recién nacidos estudiados (2.2/1,000 recién nacidos totales), dos fueron mortinatos (6.1% del total) y cuatro fallecieron tras el nacimiento (12.9% de los neonatos vivos), con una mortalidad perinatal total del 18.2%; 28 neonatos terminaron la gestación antes de la semana 37 (84.8%) y 11 antes de la semana 32 (33.3%); siete neonatos pesaron menos de 1,500 g (cuatro de ellos menos de 1,000 g). De los 31 recién nacidos vivos, 13 neonatos tenían peso menor al percentil 10 para su edad gestacional (41.9%), 20 precisaron reanimación neonatal (64.5%) y 14 presentaban leucopenia neonatal (45.2%). En la regresión logística final, la mortalidad neonatal se asoció con la gran prematuridad, independientemente del bajo peso, leucopenia o necesidad de reanimación neonatal.Conclusiones: Los hijos de madre con síndrome de HELLP presentan elevada mortalidad asociada con la alta prematuridad, independientemente de la presencia de leucopenia, bajo peso para edad gestacional o necesidad de reanimación neonatal.

AbstractBackground: HELLP syndrome is a serious hypertensive disorder of pregnancy with important neonatal problems in the newborn. The objective of this work was to determine the characteristics of these infants and its neonatal evolution.Methods: A retrospective observational study of all newborns of mothers with HELLP syndrome born in a university hospital between January 1, 2008 and December 31, 2013 was carried out. Thirty-three infants from 28 pregnancies (five twin gestations) were studied. A descriptive and comparative analysis between groups and a multivariate analysis of factors associated with mortality in the series took place.Results: Of 33 newborns studied (2.2 newborns/1,000 infants total), two were stillbirths (6.1% of the total) and four died after birth (12.9% of live neonates) with overall perinatal mortality of 18.2%. Pregnancies in 28 infants ended before 37 weeks (84.8%) and 11 pregnancies ended before week 32 (33.3%). Seven infants weighed < 1500 g (four weighed <1000 g). Of the 31 live births, 13 infants were in a <10th percentile weight for gestational age (41.9%), 20 needed neonatal resuscitation (64.5%) and 14 had leukopenia at birth (45.2%). In the final logistic regression, neonatal mortality was associated with extreme prematurity regardless of underweight, leukopenia and/or need for neonatal resuscitation.Conclusions: Children of mothers with HELLP syndrome have a high mortality associated with extreme prematurity, independent of the presence of leukopenia, low weight for gestational age and need for neonatal resuscitation.

[Newborn of mother with HELLP syndrome: characteristics and role of prematurity, low birth-weight and leukopenia in evolution]. / Hijo de madre con síndrome de HELLP: características y papel de la prematuridad, bajo peso y leucopenia en su evolución.

BACKGROUND: HELLP syndrome is a serious hypertensive disorder of pregnancy with important neonatal problems in the newborn. The objective of this work was to determine the characteristics of these infants and its neonatal evolution. METHODS: A retrospective observational study of all newborns of mothers with HELLP syndrome born in a university hospital between January 1, 2008 and December 31, 2013 was carried out. Thirty-three infants from 28 pregnancies (five twin gestations) were studied. A descriptive and comparative analysis between groups and a multivariate analysis of factors associated with mortality in the series took place. RESULTS: Of 33 newborns studied (2.2 newborns/1,000 infants total), two were stillbirths (6.1% of the total) and four died after birth (12.9% of live neonates) with overall perinatal mortality of 18.2%. Pregnancies in 28 infants ended before 37 weeks (84.8%) and 11 pregnancies ended before week 32 (33.3%). Seven infants weighed<1500g (four weighed <1000g). Of the 31 live births, 13 infants were in a <10th percentile weight for gestational age (41.9%), 20 needed neonatal resuscitation (64.5%) and 14 had leukopenia at birth (45.2%). In the final logistic regression, neonatal mortality was associated with extreme prematurity regardless of underweight, leukopenia and/or need for neonatal resuscitation. CONCLUSIONS: Children of mothers with HELLP syndrome have a high mortality associated with extreme prematurity, independent of the presence of leukopenia, low weight for gestational age and need for neonatal resuscitation.

Treatment compliance in children and adults with cystic fibrosis.

OBJECTIVES: To determine treatment compliance and how compliance was perceived by patients, parents and by a multidisciplinary team in Cystic Fibrosis (CF) patients. Also to analyse the relative importance given to each of the prescribed treatments, reasons for non-adherence and to investigate possible predictors of therapeutic compliance. PATIENTS AND METHODS: 34 CF patients (21 females), aged between 1.6 and 40.6 years, attending an outpatient CF clinic. DESIGN: cross-sectional. A self-administered questionnaire was given to all patients whilst attending a programmed visit which was used to determine compliance to different treatments (physiotherapy, nutritional supplements, respiratory and digestive medications). Patients were subjectively classified as compliant or non-compliant by medical staff involved in their care. RESULTS: Treatment compliance was greater for digestive (88.2%) and respiratory medication (61.8%), compared to physiotherapy (41.2%) or nutritional supplements (59%). CF patients considered digestive medication indispensable (94.1%), compared to nutritional supplements (44.1%). Whilst 26.4% of CF patients considered that respiratory medications or nutritional supplements influenced little or nothing in their quality of life. Comparing age groups younger patients were found to be more compliant (10.4 vs. 20.5 years p=0.008) and had less severe disease (Shwachman score 83.2 vs. 73.9 p=0.048). CONCLUSIONS: CF patients had greater treatment adherence when prescribed digestive and respiratory medications, compared to physiotherapy or nutritional supplements. Therapeutic adherence was found to worsen with age and disease severity, however improved with treatments which were perceived by patients as more important or had a greater influence in their quality of life.

[Endoscopic treatment of gastrointestinal fistulas with biological fibrin glue]. / Tratamiento endoscópico de fístulas gastrointestinales con un pegamento biológico tisular.

OBJECTIVE: We summarize our experience of endoscopic treatment of gastrointestinal fistulas with fibrin glue. PATIENTS AND METHOD: We retrospectively reviewed the outcome of 30 patients with gastrointestinal fistulas (9 internal and 21 external) refractory to standard conservative treatment for at least 10 days. Once the fistula was endoscopically located, 4 to 8 ml of reconstituted fibrin glue (Tissucol 2.0) at 37 degrees C was injected through a Duplocath catheter on a weekly basis. RESULTS: The mean age was 59 years (32-87) and 63% were men. A total of 21.9% of the patients had high output fistulas. We were able to find all fistular orifices what were located close to the surgical anastomosis. Healing time was 17 days (4-90); 2.8 sessions were required per patient (1-5) but only 2.3 sessions were required in responders. Complete sealing of fistulas was achieved in 75%; (80% in low-output, 25% in high-output and 55.5% in internal fistulas). The frequency of fistula recurrence was 3.3%. No complications related to the sealing procedure were found. Overall mortality was 10%, but only 6.6% was related to persistence of the fistula. CONCLUSIONS: Endoscopic treatment of fistulas with biological glue has a high success rate in sealing without complications, helping to speed up the healing process and reduce costs, particularly in low-output enterocutaneous fistulas.

Tratamiento endoscópico de fístulas gastrointestinales con un pegamento biológico tisular / Endoscopic treatment of gastrointestinal fistulas with biological fibrin glue

Objetivo: En este estudio resumimos nuestra experiencia en el tratamiento endoscópico de las fístulas gastrointestinales con pegamento de fibrina. Pacientes y método: Revisamos retrospectivamente la evolución de 30 pacientes con fístulas (9 internas y 21 externas) resistentes al tratamiento estándar conservador al menos durante 10 días. Una vez la fístula era localizada endoscopicamente, se inyectaban de 4 a 8 ml de Tissucol® 2,0 a 37 °C por un catéter Duplocath®. Resultados: La edad media fue de 59 años (32-87) con un 63% de varones. El 21,9% de los pacientes tuvieron fístulas de alto débito. Se pudo localizar todos los orificios fistulosos, muy próximos a las anastomosis quirúrgicas. El tiempo para conseguir el cierre de los orificios fistulosos fue de 17 (4-90) días, con 2,8 (1-5) sesiones por paciente, pero sólo 2,3 en los pacientes en quienes el sellado fue un éxito. La cicatrización completa se obtuvo en el 75% (el 80% en fístulas de bajo débito, el 25% en las de alto débito y el 55,5% en las fístulas internas). La frecuencia de recurrencia fue del 3,3%. No hubo complicaciones en relación con el sellado. La mortalidad global fue del 10%, pero sólo el 6,6% se relacionó con mantener abierta la fístula. Conclusiones: El tratamiento endoscópico de las fístulas con Tissucol® tiene una alta tasa de éxitos sin complicaciones y contribuye a acelerar el proceso de cicatrización de las fístulas, lo que disminuye los costes, particularmente en las fístulas enterocutáneas de bajo débito

Objective: We summarize our experience of endoscopic treatment of gastrointestinal fistulas with fibrin glue. Patients and method: We retrospectively reviewed the outcome of 30 patients with gastrointestinal fistulas (9 internal and 21 external) refractory to standard conservative treatment for at least 10 days. Once the fistula was endoscopically located, 4 to 8 ml of reconstituted fibrin glue (Tissucol® 2.0) at 37 ºC was injected through a Duplocath® catheter on a weekly basis. Results: The mean age was 59 years (32-87) and 63% were men. A total of 21.9% of the patients had high output fistulas. We were able to find all fistular orifices what were located close to the surgical anastomosis. Healing time was 17 days (4-90); 2.8 sessions were required per patient (1-5) but only 2.3 sessions were required in responders. Complete sealing of fistulas was achieved in 75%; (80% in low-output, 25% in high-output and 55.5% in internal fistulas). The frequency of fistula recurrence was 3.3%. No complications related to the sealing procedure were found. Overall mortality was 10%, but only 6.6% was related to persistence of the fistula. Conclusions: Endoscopic treatment of fistulas with biological glue has a high success rate in sealing without complications, helping to speed up the healing process and reduce costs, particularly in low-output enterocutaneous fistulas

Tratamiento endoscópico de fístulas gastrointestinales con un pegamento biológico tisular / Endoscopic treatment of gastrointestinal fistulas with biological fibrin glue

Objetivo: En este estudio resumimos nuestra experiencia en el tratamiento endoscópico de las fístulas gastrointestinales con pegamento de fibrina. Pacientes y método: Revisamos retrospectivamente la evolución de 30 pacientes con fístulas (9 internas y 21 externas) resistentes al tratamiento estándar conservador al menos durante 10 días. Una vez la fístula era localizada endoscopicamente, se inyectaban de 4 a 8 ml de Tissucol® 2,0 a 37 °C por un catéter Duplocath®. Resultados: La edad media fue de 59 años (32-87) con un 63% de varones. El 21,9% de los pacientes tuvieron fístulas de alto débito. Se pudo localizar todos los orificios fistulosos, muy próximos a las anastomosis quirúrgicas. El tiempo para conseguir el cierre de los orificios fistulosos fue de 17 (4-90) días, con 2,8 (1-5) sesiones por paciente, pero sólo 2,3 en los pacientes en quienes el sellado fue un éxito. La cicatrización completa se obtuvo en el 75% (el 80% en fístulas de bajo débito, el 25% en las de alto débito y el 55,5% en las fístulas internas). La frecuencia de recurrencia fue del 3,3%. No hubo complicaciones en relación con el sellado. La mortalidad global fue del 10%, pero sólo el 6,6% se relacionó con mantener abierta la fístula. Conclusiones: El tratamiento endoscópico de las fístulas con Tissucol® tiene una alta tasa de éxitos sin complicaciones y contribuye a acelerar el proceso de cicatrización de las fístulas, lo que disminuye los costes, particularmente en las fístulas enterocutáneas de bajo débito

Objective: We summarize our experience of endoscopic treatment of gastrointestinal fistulas with fibrin glue. Patients and method: We retrospectively reviewed the outcome of 30 patients with gastrointestinal fistulas (9 internal and 21 external) refractory to standard conservative treatment for at least 10 days. Once the fistula was endoscopically located, 4 to 8 ml of reconstituted fibrin glue (Tissucol® 2.0) at 37 ºC was injected through a Duplocath® catheter on a weekly basis. Results: The mean age was 59 years (32-87) and 63% were men. A total of 21.9% of the patients had high output fistulas. We were able to find all fistular orifices what were located close to the surgical anastomosis. Healing time was 17 days (4-90); 2.8 sessions were required per patient (1-5) but only 2.3 sessions were required in responders. Complete sealing of fistulas was achieved in 75%; (80% in low-output, 25% in high-output and 55.5% in internal fistulas). The frequency of fistula recurrence was 3.3%. No complications related to the sealing procedure were found. Overall mortality was 10%, but only 6.6% was related to persistence of the fistula. Conclusions: Endoscopic treatment of fistulas with biological glue has a high success rate in sealing without complications, helping to speed up the healing process and reduce costs, particularly in low-output enterocutaneous fistulas

Análisis discriminante de la adhesión al tratamiento en la diabetes mellitus insulinodependiente / Discriminant analysis of treatment adherence in insulindependet diabetes mellitus

En este trabajo se presentan los resultados de una investigación realizada con 63 pacientes diabéticos insulinodependientes del servicio de Endocrinología de un hospital madrileño. Nuestro objetivo era evaluar la relación de variables psicosociales con la adhesión al tratamiento y establecer una función discriminante que pudiese clasificar a los pacientes según el nivel de adhesión evaluado. Los resultados de nuestro estudio muestran que la adhesión terapéutica autoevaluada está relacionada positivamente con el control metabólico y que las variables fundamentales que determinan la adhesión terapéutica son las relativas a la práctica de ejercicio físico y la relación establecida con el personal sanitario (AU)

In this study we present the outcome of a research wich was carried out on 63 insulindependent diabetic patients from the Endocrinology department of a hospital in Madrid. Our goal was to assess the relationship between psychosocial variables and treatment adherence and to found a discriminant function with which it was possible to classify the patients in base to the assessed adherence level. Results show a positive relationship between self-reported therapeutic adhesion and metabolic control. We could also observe that physical activity as well as relationship with medical staff were the main variables to determine treatment adherence (AU)